Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

Abstract

Pharmacotherapy is important in older patients undergoing rehabilitation because such patients, especially those with frailty and physical disabilities, are susceptible to drug-related functional impairment. Drug-related problems include polypharmacy, potentially inappropriate medications (PIMs), and potential prescription omissions. These problems are associated with adverse drug events such as dysphagia, depression, drowsiness, falls and fractures, incontinence, decreased appetite, and Parkinson’s syndrome, leading to impaired improvement in activities of daily living (ADL), quality of life (QOL), and nutritional status. Moreover, the anticholinergic burden is associated with impaired physical and cognitive functions. Therefore, pharmacist-centered multidisciplinary pharmacotherapy should be performed to maximize rehabilitation outcomes. Pharmacotherapy includes a review of all medications, the assessment of drug-related problems, goal setting, correction of polypharmacy and PIMs, monitoring of drug prescriptions, and reassessment of drug-related problems. The goal of pharmacotherapy in rehabilitation medicine is to optimize drug prescribing and to maximize the improvement of ADL and QOL as patient outcomes. The role of pharmacists during rehabilitation is to treat patients as part of multidisciplinary teams and as key members of nutritional support teams. In this review, we aim to highlight existing evidence regarding pharmacotherapy in older adults, including drug-related functional impairment and the association between pharmacotherapy and functional, cognitive, and nutritional outcomes among patients undergoing rehabilitation. In addition, we highlight the important role of pharmacists in maximizing improvements in rehabilitation outcomes and minimizing drug-related adverse effects.

Polypharmacy and Its Association with Dysphagia and Malnutrition among Stroke Patients with Sarcopenia

“…Polypharmacy and inappropriate medications were screened, medication adherence was assessed, and adverse drug effects were observed. Medications that may affect rehabilitation, level of consciousness, nutritional status, or physical function were appropriately managed by reducing, discontinuing, or switching to alternative medications [ 42 ].…”

Association of polypharmacy at hospital discharge with nutritional intake, muscle strength, and activities of daily living among older patients undergoing convalescent rehabilitation after stroke

“…In the process of functional recovery, it is also necessary to examine whether symptomatic prescriptions for complications are administered without reconsideration [27]. While rehabilitation focuses on training for functional recovery, pharmacotherapy tends to focus on disease treatment [28]. Without considering rehabilitation and pharmacotherapy together, the negative impact of drugs on outcomes can be overlooked.…”

Effects of muscle mass and muscle quality estimated by phase angle on functional outcomes in older patients undergoing rehabilitation: A prospective cohort study

“…Third, because the cutoff values of PhA in older rehabilitation patients has not been fully established, 42 we could not determine whether our classification method was valid. Fourth, other indicators, such as the number of medications 43‐45 or swallowing functions, 46,47 are also associated with functional outcomes in older patients undergoing rehabilitation, but these parameters could not be assessed. Fifth, because we did not evaluate the changes in SMI or PhA longitudinally, it remains unclear whether improvement in muscle mass or muscle quality contributed to physical function in our study.…”

“…Third, because the cutoff values of PhA in older rehabilitation patients has not been fully established, 42 we could not determine whether our classification method was valid. Fourth, other indicators, such as the number of medications [43][44][45] or swallowing functions, 46,47 are also associated with functional…”